Sexual Harassment Complaint Form
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10File: ACAA-E
SEXUAL HARASSMENT COMPLAINT FORM
Date of Report
Employee/Student Name
Position or Grade _____________________________ Building
Date and Time of Alleged Harassment
Location of Alleged Harassment
Name of Alleged Harasser
Position or Grade _____________________________ Building
Description of the Incident(s)
Name of Witnesses, if any, and Involvement
Your Reaction
Signature of Complainant
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